Reoperation after failed esophagomyotomy for achalasia

Area of Science:

• Gastroenterology
• Surgical Gastroenterology
• Esophageal Surgery

Background:

• Achalasia is a primary esophageal motility disorder.
• Surgical myotomy is a common treatment for achalasia.
• Recurrent symptoms can occur after initial surgical intervention.

Purpose of the Study:

• To investigate the causes of recurrent dysphagia after surgical treatment for achalasia.
• To evaluate the effectiveness of remedial surgical interventions for postoperative dysphagia.

Main Methods:

• Retrospective review of 49 patients undergoing surgery for achalasia between 1975-1985.
• Detailed analysis of 12 patients with prior transthoracic esophagomyotomy.
• Preoperative investigations and intraoperative findings to determine causes of dysphagia.
• Review of remedial surgical procedures and postoperative outcomes.

Main Results:

• 12 patients had prior surgery; 8 experienced recurrent dysphagia within 9 months.
• Causes included inadequate myotomy, disrupted fundoplications, hiatus hernia, and incorrect initial diagnosis.
• Remedial surgeries included repeat Heller myotomy, Hill repair, and fundoplication takedown.
• Eight patients had good results, two required further surgery, and one needed dilatations.

Conclusions:

• Causes of recurrent dysphagia post-achalasia surgery are varied.
• Individualized investigation and treatment are crucial for these patients.
• Remedial surgery can improve outcomes, but initial adequate surgery yields better results.